Cost-Utility of Fluticasone Propionate/Salmeterol and Fluticasone Propionate Monotherapy in Step-Up Treatment of Childhood Asthma.

INTRODUCTION: In children aged 6-11 years who have not responded to daily low-dose inhaled corticosteroids, it is recommended to increase ICS to a medium dose plus as-needed SABA reliever, or to change to combination low-dose ICS-LABA plus as-needed SABA relief. Recently, fluticasone propionate and salmeterol (FSC) have been shown to be more effective than fluticasone propionate alone in preventing exacerbations in patients with eosinophilic asthma. This study aims to evaluate the cost-utility of FSC versus medium doses of FP alone in Colombian patients who do not respond to low-dose inhaled corticosteroids.

MATERIALS AND METHODS: A probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with severe asthma in Colombia. Cost-effectiveness was evaluated at a willingness-to-pay (WTP) value of US$5180. This analysis used quality-adjusted life years (QALYs) and costs from a third-payer perspective over a 5-year time horizon.

RESULTS: FSC incurs a higher cost than FP alone, with a mean incremental cost of USD 273; it provides a marginal improvement in quality-adjusted life years (QALYs) of 0.06, yielding an incremental cost-utility ratio (ICUR) of USD 4806 per QALY gained. These results imply that FSC might be a cost-effective alternative at a willingness-to-pay (WTP) threshold of USD 5180.

CONCLUSION: This study's findings are aligned with previous evidence on the economic value of ICS/LABA combinations, which found similar cost-effectiveness ratios for ICS/LABA therapies within accepted thresholds. Our probabilistic perspective supports FSC's potential as a feasible option in clinical practice for achieving better asthma control in children.